【摘要】目的分析Kt 与胱抑素C 清除率的相关性，证实Kt 在评估中分子透析充分性上的优势。方法选取在首都医科大学附属北京同仁医院肾内科血液净化中心行高通量维持性血液透析的患者资料。根据体表面积(body surface area, BSA)计算目标透析剂量Kt[1/(0.0237/BSA+0.006)]。根据Kt/V 计算实际Kt 值；对透析前胱抑素C 水平、胱抑素C 清除率(cystatin C reduction ratio，CCRR)进行单因素分析；对CCRR 进行多元线性回归分析；根据Kt 及Kt/V 达标情况进行分组研究。采用SPSS 22.0 软件进行统计学分析。结果本研究共纳入患者56 例,其中男31 例，女25 例。透析前胱抑素C 水平不受透析患者一般资料影响；与Kt/V 和Kt 均达标患者相比，在Kt/V 达标而Kt 不达标组，CCRR 更低(t=3.394, P=0.001)，甲状旁腺激素水平更高(Z=-2.621,P=0.008)。单因素分析中CCRR 的影响因素较多，但经多因素分析后仅Kt 差值(实际Kt 值-目标Kt 值)与CCRR 线性相关(β=0.797,P=0.014)。结论胱抑素C 可用于评估透析患者中分子毒素水平；Kt 可用于评估高通量血液透析患者中分子毒素清除水平，弥补Kt/V 在评估充分性方面的不足。
【Abstract】Objective To analyze the association between Kt and the clearance of medium molecular toxin in uremia. Methods We collected the data of high-flux maintenance hemodialysis patients in the dialysis center of Tong Ren Hospital. The target Kt was calculated by the formula: target Kt =1/[0.0069+(0.0237/BSA)]. Calculate the actual Kt according to Kt/V; Univariate analysis was performed for prEdialysis cystatin C level and cystatin C reduction ratio (CCRR). The CCRR was analyzed by multiple linear regression. The analysis was performed by SPSS (Version 22.0). Results Among 56 patients, 31 were males and 25 were females.
The prEdialysis cystatin C was not affected by the characteristics of dialysis patients. Compared with the patients who meet both the target of Kt/V and Kt, the patients who only meet the target of Kt/V had lower CCRR(t=3.394, P =0.001) and higher parathyroid hormone (Z=-2.621, P=0.008). In univariate analysis, there were many factors correlated with CCRR, but after multiple regression analysis, only Kt difference (the actual Kt value - the target Kt value) had a linear correlation with CCRR (β=0.797, P=0.014). Conclusion Cystatin C can be used to evaluate the level of medium molecular toxin in dialysis patients. Kt can be used to evaluate the medium molecular clearance in high-flux hemodialysis patients, to make up the restrictions of Kt/V in accessing adequacy.
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